Perceptions of the healthcare providers regarding acceptability and conduct of minimal invasive tissue sampling (MITS) to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study
Perceptions of the healthcare providers regarding acceptability and conduct of minimal invasive tissue sampling (MITS) to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study
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DOI：
10.1186/s12913-020-05693-6
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发表时间：
2020-09-04
影响因子：
2.8
通讯作者：
Meena, K. R.
中科院分区：
文献类型：
--
作者：
Das, Manoja Kumar;Arora, Narendra Kumar;Meena, K. R.
印度是全球五岁以下儿童和新生儿死亡和死产比例最高的国家。诊断性尸检虽然对死因鉴定有用，但接受程度有限。微创组织取样（MITS）是尸检的替代方法，用于确定死因（CoD）。与试点MITS实施相关的形成性研究旨在记录医疗保健专业人员的看法和态度以及实施障碍。方法在印度新德里的一家三级医院进行的探索性定性研究包括医院工作人员。对来自儿科、妇产科、法医科的医生、护士和辅助人员进行了深入访谈。归纳数据分析，以确定新出现的主题和代码。结果共进行了26次访谈（医生，n = 10;护士，n = 9和支持人员，n = 7）。几乎所有的专业和支持人员都对MITS及其在CoD识别（包括共存和基础疾病）方面的优势持积极态度。有些人认为对诊断不明确的病例应进行MITS。所有参与者都认为，MITS将是可以接受的父母，由于非毁容和首选的那些谁在过去的原因不明的儿童死亡或死产。接受MITS的关键因素是适当的沟通，建立信任，高级医生的参与，以及顾问在死亡前的参与和人员的培训。为了实施和维持MITS，机构当局和政府利益攸关方的参与至关重要。结论MITS是医生、护士和支持人员可以接受的，对于更好地识别死亡和死产的原因至关重要。确定了在印度医院实施MITS的关键促进因素和挑战。它强调适当的技能建设，咨询，系统组织和购买从机构和卫生当局的MITS的维持。
Background India contributes the highest share of under-five and neonatal deaths and stillbirths globally. Diagnostic autopsy, although useful for cause of death identification, have limited acceptance. Minimally invasive tissue sampling (MITS) is an alternative to autopsy for identification of the cause of death (CoD). A formative research linked to pilot MITS implementation was conducted to document the perceptions and attitudes of the healthcare professionals and the barriers for implementation. Methods This exploratory qualitative study conducted at a tertiary care hospital in New Delhi, India included the hospital staffs. In-depth interviews were conducted with the doctors, nurses and support staffs from pediatrics, neonatology, obstetrics and forensic medicine departments. Inductive data analysis was done to identify the emerging themes and codes. Results A total of 26 interviews (doctors,n = 10; nurses,n = 9 and support staffs,n = 7) were conducted. Almost all professional and support staffs were positive about the MITS and its advantage for CoD identification including co-existing and underlying illnesses. Some opined conduct of MITS for the cases without clear diagnosis. All participants perceived that MITS would be acceptable for parents due to the non-disfigurement and preferred by those who had unexplained child deaths or stillbirths in past. The key factors for MITS acceptance were appropriate communication, trust building, involvement of senior doctors, and engagement of the counselor prior to deaths and training of the personnel. For implementation and sustenance of MITS, involvement of the institute authority and government stakeholders would be essential. Conclusions MITS was acceptable for the doctors, nurses and support staffs and critical for better identification of the causes of death and stillbirths. The key facilitating factors and challenges for implementing MITS at the hospital in Indian context were identified. It emphasized on appropriate skill building, counseling, system organization and buy-in from institution and health authorities for sustenance of MITS.